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HomeMy WebLinkAbout1626DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34.13 -1 -18 BOX 15 rIr T r, IN IN +. r '- - '�� ol IN , ' i' , 01626 y'..;,�`,.,'� t PUTNAM COU1VT1l DEPAR i< `'�F�, 'OF HIr � �,b g64 Division of Environment /Hale/ h_ Servioess, rme/ N Y 1 €_. - ` permit' w ,R $ $1 _ CERTIFICATE. OF CONSTRUCTION COMPLIANCE FOR SEWAGE °DISPOSAL SYSTz IIA�' 7 Patier "son r 7. .. 'Town or VII lage ,. -1: ocbted` of E r ..StVn et - �� rax. MaP 78• nLocli 1 Owner Denn l S' curry Former y max Hap toe'w 4O subd. rot w Separate sewerage -System built by Own Addreu •L'on,g ' rew Rd,. , G'a.clnel , NY 10512 'Consisting of 1.000' Gai. septic. Tank and 375 flhed�•T.:feet x:.24" width trench Other requirements water supply. Public Supply From X Private Supply Drilled By M' 11 Dri1'l chg Co:_., •fnc. Address gr.eWSter; 'NY 10509 Frame Three 7/15/81 Building. o. : P*rinit Ha's Erosion Control. Been tompletedt Yes-Reta rh hq - :M4'1'1 I certify that "the system(e) as listed .serving. the above premises were constructed'esientially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the. standards, rules.and regulations, in' accordance wit h.the filed plan, and the permit issued by the Putnam County Department Of'Health. . Date MarCh_1 .' 19$5. Certified•Dy ry P.E. 'X . fa.A. Address $• Ga rme.l. N 10 2 l.lcena No...29,206 Any person occupying premises served by the above syst'e'm(`) s conditions resulting from such usage. Approval of the. sepan available and .the approval of the •private, water supply. shall, bec subject to modificatio or change when, In ,the judgment of Date By Rev. 9-81 V " II promptly take sueh.action as. sewerage, system 'shall become ie null. and void• when a pu ei of:Heaith c maybe neeesary,to secure the correction of any unsanitary null ind vold as soon as a public sanitary sower becomes w supply becomes available. Such approvals are ti lion, modification or change Is necessary. Title er� :J,s� . % i��,�uA Denis i s 'Cum TM 78 Owner or, urc aser. of Building Section Roder Mayes 1 ..,_�.;;.:..B}zaL =ltl- rig -= Construe =t:edaeby�._ _: _. ��.,,.....�.a_. - .:�=::rBl.��l•�_�.._.... •. .�.,..�,..:-��:�._.e:s:,�,� - �_.�...,.,.....�...,....._ Fair Street Location - Street Patterson Municipality Frame Building Type 40 Lot Sunny Acres Subdivision Name 23 Subdva Lot # GUARANTEE OF SEPARATE SEWAGE SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his success- ors,, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of initial use of the sewage disposal system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determin- ation of the Director of the Division of Environmental Health Services County - -- -Department of - Heath _..a- sw;o•- wYaethe.rwor..not_ the._�fa.il.- :__.:.: ure of the system to operate was caused.by the willful or negligent act of the occupant of the building utilizing the system.' Dated this 1st day of March 19 85 Signature Title Owner Corporation Name if corp L,oggY tew, ,R d , , C a nmej ,, .ICY i Q51 I Address - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health WA ? ER ANALYSIS REPORT SAMPLE NO. 4724 SOURCE: Dennis Curry Fair Street Patterson, New York COLLECTED: November 19# 1981 BY: Mill Drilling, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method Well This result indieattt the saltM of the sample was of - satirfaetery -' sanitary quality whtn the sample was rolliettd.. 0 per 100 snl. November 25, 1981 Bickwit P. E. Director A WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services r COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report is to..be completed by well driller and submitted.to.County..Healtr Department together with laboratory report; of. .. -"analysiT=of water °sample indicating water is of'sati0adtory bacrdC0 q`u "a"liiy "beio�e certifica e of construction compliance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION NAME ADDRESS OWNER Dennis. Curry Longview Road, Carmel, New York LOCATION (No. & Street) (Town) (Lot Number) OF WELL Fair Street Patterson, New York 43 PROPOSED D DOMESTIC BUSINESS ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL USE OF ROTARY AIR PERCUSSION PERCUSSION WELL 11 El ❑ ❑ DIAMETER (inches) SUPP Y INDUSTRIAL CONDITIONING ((SSpeciffy) DRILLING COMPRESSED ❑ � ❑ CABLE OPBER IPMENT EQUIPMENT ROTARY AIR PERCUSSION PERCUSSION ) CASING LENGTH (feet) DIAMETER (inches) WEiuHT PER FOOT ® ❑WELDED DRIVE SHOE LD ❑ (W�S CLING TED? M DETAILS 70 2 6 19 THREADED YES NO YES NO YIELD ❑ ❑ R HOURS G.P.M. YIELD (G.P.M.) TEST BAILED PUMPED COMPRESSED AIR 4 75 75 WATER MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST feet) Depth of Completed Well LEVEL 77 285 in feet below Land surface: 285 MAKE ILENGTH OPEN TO AQUIFER (feet) SCREEN DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL Diameter of well including GRAVEL SIZE (inches) FROM (feet) TO (feet) PACKED: gravel pack (inches): DEPTH FROM LAND SURFACE SketcA exact location of well with distances, to at least FEET to FEET FORMATION DESCRIPTION two permanent landmarks. 0 42 Hard Packed Clay 42 60 Soft Brown Weathered Ledge 60 285 Hard Grey- & Black Granite r 17.e 11 Proposed Dwelling ru 0 If yield was tested at different depths during drilling, list below. r-1 FEET GALLONS PER MINUTE A SDS 200 3h 265 20 285 75 ., Fair Street DATE WELL COMPLETED DATE OF REPORT WELL DRILLER �g to 11/19/81 12/2/81 T �.�- Robert M. Mill, President -MILL DRILLING COo a INC. c r1a zZ I�1 A 6 o � U 4p0'��vLl� '(A�K Fa2✓"r1�'J -x'17 1✓'opI✓I �r a.�rc -I�LI Jl ,4, �• -_- PI Pa Alt I I =7" Ip { �• ra d I JiJI-IcTiorJ P�� IGAL Alt I�,ao L�AL.• PR.c -cas1T LbTC�iLlalrh � �Ir v,c. �iP bl�. 0�IJ } N � } E—:=77 =kutn= County Department of Health j Division of T:nvironaantal health Services i : A en -1' :c ^.co with ��PPl cal - !,:.as of the ?u Cou.�J a -L:, ant. a s "AS' UILI' DATA Structure located from survey by surveyor noted bolos®' Well located by: Surveyors survey•_ -- ❑_ - - _ Wall drillors report En91neorn mesuromonta _._ Ton h, boxes, pits, gallortoe th laterals lo•catod by:Contractors Eng4acsrs_ ` ' H o Olth da,pt: Field Inspection by: Health dopf ® dot Enginoor ® date'- NOTES: 4' ea, 37%b' 3 - bIMENSIONS A E 1 UIr B- E a III °— — 11 _ _ QpFLg3laNp� A - G _r O� _ P B - G ° -�I -P _ yv aN, Rg� ESC A - J � ® A - -'B - K -- -- - -� r '•A�s'ry No JH 114 1 1 H M I ZY V D OyY A:_I�G LOCATION Street:_r -ial IZ _SZ2� 7- .77— �^J" Town:`�/�Z [�e5o1�000ntY:��JTI �%IV StofO �•J' s -<; SUBDIVISION -, -Lji1 1j-1('A_�2_G_�_Cv") ��3_ •.. Me P. /-r X1Zs�� Bloc*.._ I LOT No_ Builder:_O Wj_�(� _ _ Surveyor:�i�r�i`l L1D L -- 4 b - ;/ Drawn: I Date : Scale: a Job. 2 D.D 4• 3. -2 -8 I = 3v ,� JOHN H. PR ENTISS 'PE, CONSULTING ENGINEER c =7" ON n d; Z � , I�,ao L�AL.• PR.c -cas1T LbTC�iLlalrh � �Ir v,c. �iP bl�. 0�IJ } N � } E—:=77 =kutn= County Department of Health j Division of T:nvironaantal health Services i : A en -1' :c ^.co with ��PPl cal - !,:.as of the ?u Cou.�J a -L:, ant. a s "AS' UILI' DATA Structure located from survey by surveyor noted bolos®' Well located by: Surveyors survey•_ -- ❑_ - - _ Wall drillors report En91neorn mesuromonta _._ Ton h, boxes, pits, gallortoe th laterals lo•catod by:Contractors Eng4acsrs_ ` ' H o Olth da,pt: Field Inspection by: Health dopf ® dot Enginoor ® date'- NOTES: 4' ea, 37%b' 3 - bIMENSIONS A E 1 UIr B- E a III °— — 11 _ _ QpFLg3laNp� A - G _r O� _ P B - G ° -�I -P _ yv aN, Rg� ESC A - J � ® A - -'B - K -- -- - -� r '•A�s'ry No JH 114 1 1 H M I ZY V D OyY A:_I�G LOCATION Street:_r -ial IZ _SZ2� 7- .77— �^J" Town:`�/�Z [�e5o1�000ntY:��JTI �%IV StofO �•J' s -<; SUBDIVISION -, -Lji1 1j-1('A_�2_G_�_Cv") ��3_ •.. Me P. /-r X1Zs�� Bloc*.._ I LOT No_ Builder:_O Wj_�(� _ _ Surveyor:�i�r�i`l L1D L -- 4 b - ;/ Drawn: I Date : Scale: a Job. 2 D.D 4• 3. -2 -8 I = 3v ,� JOHN H. PR ENTISS 'PE, CONSULTING ENGINEER c QQ 1 ' O I PUTNAM COUNTY DEPARTMENT DF HEALTH Division of. ;Environmental. "Health' Services Carmel, •N:' Y. 10512 64 (� S0 9 CONSTRUCTION PERMIT: FOR SEWAGE bISPOSAL SYSTEM . 0'_dtt2Y'SOn ' Town pr Village Fai r., Street r :78� Located =•at• - Tax Map Subdivision Sunny Acres .— Lot Lot .roe S01964 Oenms ;Curry ongyiew Rd Owner Address Frame; .21112' F.+ Car`Mel - ::NY 10512 , Building Type Lot Area Three 600 Gal.,' 1.513 Number of Bedrooms Design Flow, -1 Total Habitable Space Square Feet Separate Sewerage system to consist , of 1000. ', Gel. Septic Tank and ...375 L.F. x 24" Width Trench To be constructed by aERN1+4`I�S Address b Water Supply Public Supply From Private Supply to be drilled by R��.. •Address. Other Requirements None. I represent that 'I am 'wholly antl completely responsible for the design ndm. location of th_e proposed system(s) ; 1) that the separate sewage disposal system atiove.described will be constructed as shown on the approved.ameridment there to and:'in accordance with the standards; rules and regulations of e u nam, , County. Department' of .Health; and that on completion thereof a'�Certif,icate: of- Construction`Compliance" satisfactory to the Commissioner of Health.will be submitted to.the'Department, and a written guarantee will-be furnished the owner his successors, heirs or.assigns by the builder, that said builder will place in good. operating ,condition any part of said ,sewage disposal systerii. during'•the period of: two (2) years immediately following. the date of the lssu ance of the approval of. the. Certificate of 'C' onstruction Compliance of the original system or 'a y repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installed_ in accordance with 4the, a ndards, rules and regulations • of the Putnam. County Department of Health.`. .Date 7 July. 198 Signed P.E. X R.A. Address . -R. D.. 9 FAtr r t 'Carmel NY 10512 License. No. 29206 ;,.APPROVED FOR CONSTRUCTION This approval'expires one y . from the date issued unless co ruction .of, the; building has been undertaken.and Is ,•revocable for, cause or may bg amended or modified'when consid -necessary -by" the Commission f Health. Any, change' or alteration of construction requires a new permit. Approveeddffor disposal'of,domesti nil y wage,.•an private. su ' nIX. Date �"r .�+� BY Title Y nmaz=zz ==ez, I Pe) r4 F— o kN\ 0 N .6 1 1� R%N Ni No 4orlyc'21 -5-1�9 t �. PUTNAM COUNTY, DTI RTMENT Of HEA' D I COUNTY OFF-ICE B.UILDtN'G---===-="T- CARMEL? NEW YORK-10512 Pd;,, 7 T. C. IS 74CI ke 892../0• TITLE NO. PREPARED FOR .S., 198/ Said map filed in the PUTNAM County Clerk's Off -ice, Division of Land Records t1pri l ZZ, 19 BO as Map .No. 62a -- Scale: - I "= 30' - _ Possession, only where ind'ica'ted Surveyed April 15,1WI and map prepared Rpri! New York Stare Licensed -Surveyor No. 34 Guaranteed to: In accordance with the existing Code of Practice for Land Surveys as adopted by The New York State Association of Professional Land Sur - veyors, Inc. Alteration of this document, except by a licensed Land Surveyor, is illegal. All certifications are valid for this map and copies thereof only if said reap or copies bear the impressed seal of the surveyor whose signature appears hereon. H. STAUEY •hHINSON LAND SURVEYOR e 173 Lu n - i­on A venu j' a �.IT. KISCO, N. Y. tcr;r.erfy Fo;,,ler Amclafes PUTNAM COUNTS. DEPARTMENT .OF.HEALTH 'DIVISION OF ENVIRONMENTAL HEALTH SERVICES "''`'' OFFICE BUILDING;" CARVEL, X. Y.' :10512, ',,, DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NOo+ Owner Address �a } r S'�• Located at (Street S' j 8 R1ock ,� Lot 4.0 F cat e.. neare�oss;.. s ree Muni,cipaliy,�yy Watershed„'.,, ...SOI ".,PERCOLATION TEST DATA .REgUIRED TO BE,; UBMITTED. WITH,,APPLICATiONS Hole. Number ..,.:...._:... CLOCK:...TIME . ` PERCOLATION ...�. ';PERCOLATION Run Elapse DeptF1 to Water Water Level ` No..,_­­....,_..­. Time .. From: Ground Surface in Inches...., Soil Rate Start = Stop'. Min. Start Stop Drop in Min. /ih drop Inches. Inches Inches 3. /a,.::.... /0 �-Z 2 . _.: �. G- :- _ -- 7. 3.�a3¢ J Rim 7 21 AT, of ki 5 ; j U L 8 1981: . e Notes: .,' T Ats to: be repeated at same depth until a roximately equal soil rates are obtained 8,t each percolation test hole.. All data to be submitted for .. review:;. :. •.: . °:'2) DejAh: measurements. to be made from top of hole. TEST PIT DATA REQUIRED TO- BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH L G.L.- 611 ccdo s, 12' 181 2411 3011 11 Du 6611 7211 7811 84 ..INDICATE L A CH GROUND WATER IS"ENCOUNTERED INDICATE MfVEL "TO CH WATER IEV L ISES, AFTER BEING ENCOUNTERED TESTS MADE BY A�?jW 2 -J& 101 Am (gj&);LDate ©jyllgl DESIGN Soil Rate U.sed14in/1'lDrop: S.D. Usable Area Provided— 3; 7 5-V Q No. of BedroomS.T J) 0 0 Gals' 4. k Septic,-Tank Capacity. Type Absorption Area Pro_v1_d_e_(1 Byy�. -'L-F-x24­ 5b" width tre h6 h. Other. Address THIS SPACE L* FOR USE BY'HEALTH.. DEPARTME NT 0 Soil Rate Approved Sq. Ft/Cal. PUTNAM COUNTY; DEPARTMENT - 'OF HEALTH I. Division of, Environmental A41th Services,'Carmel, N. Y. 10512. .. CERTIFICATE {OF CONSTRUCTION COMPLIANCE. FOR :_SEWAGE DISPOSAL;SYSTEM %�TT./�'•5�4�/V - t 7= '' "Town, of Village i Looted ;at f Block Owner /C,. G..Llie�^1� Tax Map Lot # subd,.'µ Separate Sewerage';System built by' Address Cohsis4ing of _Qal: Septic Tank and. ` a?+ SL ' �(, �) r . �L� _ P7 Other requirements Water Supply: Public S66PIY From �. Private Supply. Drilled By /V / %��•.,: "' /GLI�xJ �� Address /-aCl� Building Type p No.: of Bedrooms Date Permit Issued Has Erosion Control Been Completed? �✓ I certify hat the'.s stem {s) as listed serving the above y'as shown on the plans of-the y y q premises;•were coristructed.essen £ iall p completed work (- copies • of ;which are attach"),.' in adcoidance 'with the':atandar3s, rules and'regulati ac cordance'ivith'the filed plan, and the permit issued by'the Putnam County Departaient:Of Health: Date f' �K y �� r fi P.E. R.A. Ce r R .. , ti ed Dy -_ AddressCrZ C /iL Lteenie No.e �` 30 d• Any. person occupying premises ae veil, by he above - systems) shall promptly:,take such'iction as may, be necessary to secure the correction of any unsanitary conditions resulting; from, such' usage; : Approval' of•the'separate sewerage system• - shall become null and void as soon as public sanitary sewer 'becomes available and the, approval, of the' private water supply. hall become `null-and ,void when a public water su y becomes available. Such approvals are subject to modHicatlon , or change. when, 'in the' Judgment- of the Co ne of Health, such re n, modification or change Is necessary. - _ 71 r jR Date Title se WELL COMPLETION REPORT 3)71 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report ,is,to,be completed_by, well driller and submitted to County Health. Department together with laboratory report of_...: _. analysis of water sample indicating water Is of satisfactory bacterial quality before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION NAME ADDRESS OWNER Joan Curry Lone Vieux Road, Carmel N.Y. 10512 (No. 6 Street) (Town) (Lot Number) LOCATION OF WELL Fair Street Patterson; N.Y. NESS I ❑ ❑ ❑ TEST WELL PROPOSED DOMESTIC EST BLISHMENT FARM USE OF WELL ❑ F] ❑ CONDITIONING OTHER SUPPLY INDUSTRIAL DRILLING COMPRESSED CABLE ❑ ❑ El EQUIPMENT ROTARY AIR PERCUSSION P RCUSSION (specify) CASING LENGTH (feet) DIAMETER (inches) 6 WEIGHT PER FOOT 19 ® El j - S OE RNO C'iC5lfG D DETAILS 6" THREADED WELDED LJYES YES NO YIELD HOURS G.P.M. ❑ ❑ ® COMPRESSED AIR 4- 7 YIELD (G.P.M.) 7 TEST BAILED PUMPED WATER MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST (feet) Depth of Completed Well LEVEL 60 3 45 in feet below land surface: 345 MAKE LENGTH OPEN TO AQUIFER (feet) SCREEN DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL Diameter of well including GRAVEL SIZE (Inches) FROM (feet) TO (feet) PACKED: gravel pack (Inches): DEPTH FROM LAND SURFACE FORMATION DESCRIPTION. Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET a 0 32 Hard Pan c � o �� 32 50 Soft Brown Ledge u 345 Hard Bed 1 ock .58 If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE 200 1 300 212 345 7 DATE WELL COMPLETED DATE OF REPORT WELL DRILLER (Signature) 8/15/79 3/17/79 t . ... _._._2 BRE`SiER� LAB01'ORlES Box 224 = BREWSTER, N.Y. WATER, ANALYSIS REPORT SAMPLE NO. L ,'7 r` SOURCE: T, ' __ _ i - COLLECTED: BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method per 100 ml. This result indices* W the . sourte of the iamplt was of satisfattery sanitary quality when . tht sample was tolletted. ............................ e \l Bickwit P. E. Director r.. 21) FAI R (Sl T R E- T T VIA S T E N\l EN 0',^)VC)'T-RU` PU —IN AM -,4E AILT VA ZEP-17. NO V 4 E T H, K c. lz 1"', �00' F, 7 A \,,V E L L-.. 97� ii N C.� Cnh REVISIONS GEORGE A. HAUGHNEY, P. E. 4 Alf CONSULTING ENGINEER Route 52 Carmel, New Yoek 10512 TITLE EWq 17) 474!"M A 043 40- 04 ss LEM BY DRAWING NO. SCALE 30' C= DATE 'f i t'll -- CVD. B Y • :r. Owner or P urc aser of B ing Municipa tty C� Building Constructed by is j'A ,e&-C- "7 ocatioonn - Street Building Type -�e'cti-on Block Lot GUARANTY OF SEPARATE SEWAGE-SYSTEM I represent that I am wholly and completely - responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guaranty to the owner, his succes- sors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of initial use of the sewage disposal system, or any repairs made'.by me to such system, except where the failure to operate properly is.caused by the willful or negligent act of the occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the de- termination of the Director of the Division of Environmental Health Ser- vices -of the-Putnam County Department of Health as to whether or not the failure of the'system to operate was caused by the willful or negligent .act of the occupant of the building utilizing the system. Dated this �._.. day of 192-9 Signature Title If corporation, give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health zy PU TNAM COUNT DEPAR'TAh[El T OF H EA1L'TH DiviSion ci Environmental Heeth Services, Carmel; N.-Y.. 10512 CONSTRU GOON" PERMIT' :FOR SEWAGE'S DISPOSAL SYSTEM,. TTY �O _ T o Tax � Map # ' Town Village - - . Located at SUbdiV iSiOn '°'� "f(� LK:G Tax Map L"ot # r Subd.: Owner d1� �'—' Address Area Lot Building TYPe --- L Number ci Bedrooms _ _ De sign Q � Total - Habitable Space Square Feet ®00 Sa Separate Sewerage System to consist- of _ Lr Gal Septic Tank and p/ ft. 2' trench /. ( )' ( x )leaching pits , A To be` Cori ;tiuGfed by;_:ila:— ., Apdiess - Public .Supply •;From Water,:Su'Pply: - -__. � , — }� - • Private Supply. to be drilled ,by; Address Other_- RQquirements - ___ e I represent that am w filly and co p1eLE1y responsible for the design, and location of 'the proposed system (s) 1) that•the separate sewage disposal system` above described; will;be - ;constructed. as shown- on`the approved attachments hereto. and in accordance with the standards,, rules and regulations of the'P,gtnam county - Department, Of Health aiid'ahat on 'completion thereof a "Certificate of Construction Compliance satisfactory to the .Commission er of !Jea, 'will be submitted; to the Department and a`,written: guarantee will,be furnished the owner;' his successors; heirs.-or -by „the build .. ; % er, t:hai'said: builder will place in good 'operating condition any part ' of.said -_ sewage disposal 'system',during the period ",of two (2),years immediately followigq the.: date of the issuance_of.the approval of the 2) that the drilhed,vell described.abode. will be located `as .e dards rules •a /n{ /1 iey{;lation5 of the 1?utnam County Departure Date �/,. � /�� t Of ;Health - " APPRO.VED FOR GDf�ISTRUCTiON This approval expires one year from tit revocable for: ysuse'or may be amendedfor modified when considered neces require; a new - permit.: Approved for disposal of domestic sanit ry g s t Date By OC date issued. ynl c by'•the.Comm' Sione of the. original system or any repairs thereto; i well will be'Iiit led in accordance with . the,stan - ” PE RA License, NO: )truction 'of the building has been undertaken and is of Health. Any change -or alteiatlon.oUcon'structiop nnlu -U-w�' Title PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner 2,t2Z Address IWIZ Located t (Street gj/&,6 o�t� �4D Sec. Block Lot �ind1ca e nearest cross s ree Municipality. A7'7j'e5FJ'0A1 Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Elapse Depth to Water Water Leve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 2/P- o SC .5 Cog' 3 40/- 4109 5- ,vs �6 / `o 5 1 2 3 5 Notes: 1) rates are for review 2) Tests to be repeated at same depth until approximatelyy equal soil obtained at each percolation test hole. All data to be submitted Depth measurements to be made from top of hole. -1 411ra - x;17 �" CPS- 5 1 2 3 5 Notes: 1) rates are for review 2) Tests to be repeated at same depth until approximatelyy equal soil obtained at each percolation test hole. All data to be submitted Depth measurements to be made from top of hole. DEPTH G.L�: • 6" 12" TEST PIT DATA REQUIRED TO-BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. f HOLE NO. HOLE NO. - ... s,.- ....._._.... .,.y _a _ -._rte ... ._ .. "' ,. _., .....,,..... ...y;.. �T 24" 3011 36" 42" 48" 5411 60" 72 78« 84" INDICATE LEVEL IT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY 7.�, A Date DESIGN Soil Rate Usedp -.5' Min/l "Drop: S.D. Usable Area Provided �,qvo No. of Bedrooms Septic Tank Capacity ©0 Gals. Type,qdveV. Absorption Area Provided By �So L.F <x24 ")(+ width trench. Other i Addresstljc S,� ✓�/-� _ ure i THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: ✓r� Soil Rate Approved Sq. Ft /Cal. Checked by �dj3111i,,3,0 ate_ SEALv THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: ✓r� Soil Rate Approved Sq. Ft /Cal. Checked by �dj3111i,,3,0 ate_ Al O I 1'•� i 3 I. '£- 7_DP�°J6 l'•, EMI •� ^yr� a � � �' �' j � �� IA r P a.. Lam• t 4 C + n � r � � �• � jai 1 � �•� . _ "` ' �` r' � sa� • / / _ a PA+n,i hod\ j I � \ `\ <.... -e, ,.,',•Jim /.c. /